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. 2001 Jan;85(1):30–36. doi: 10.1136/heart.85.1.30

Assessment of left ventricular long axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe aortic regurgitation

D Vinereanu 1, A Ionescu 1, A Fraser 1
PMCID: PMC1729596  PMID: 11119457

Abstract

OBJECTIVE—To identify variables that could be applied at rest to diagnose subclinical ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.
DESIGN—Cross sectional study.
PATIENTS—Left ventricular long axis contraction was studied using tissue Doppler and M mode echocardiography in 21 patients with no symptoms (New York Heart Association (NYHA) functional class ⩽ 2a) but severe aortic regurgitation (jet area/left ventricular outflow tract area > 40%).
MAIN OUTCOME MEASURES—Left ventricular ejection fraction (LVEF) at baseline and peak exercise (Weber protocol), cardiopulmonary function, and left ventricular long axis function at rest (peak systolic velocity and excursion of the mitral annulus).
RESULTS—In 11 patients, ejection fraction increased or did not change (from mean (SD) 55 (5)% to 58 (4)%, p < 0.05) (group I); in 10 patients it decreased by > 5% (from 54 (4)% to 42 (5)%, p < 0.001) (group II). Exercise ejection fraction was < 50% in all patients in group II. At rest, there were no differences between the groups in ejection fraction, left ventricular diameter indices, wall stress, and short axis contraction. However, patients in group II had reduced long axis contraction compared with group I: peak systolic velocity 8.6 (0.6) v 11.9 (2.2) cm/s (p < 0.001); excursion 11 (2) v 14 (2) mm (p < 0.01). A resting velocity of < 9.5 cm/s was the best indicator of poor exercise tolerance (sensitivity 90%, specificity 100%).
CONCLUSIONS—Markers of reduced long axis contraction may provide simple and reliable indices of subclinical left ventricular dysfunction in asymptomatic patients with severe aortic regurgitation.


Keywords: aortic regurgitation; long axis function; tissue Doppler echocardiography; exercise echocardiography

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Figure 1  .

Figure 1  

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M mode trace of medial mitral annular motion recorded from an apical window. Ex, systolic excursion. Scale, 1 cm per division.

Figure 2  .

Figure 2  

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Pulsed wave tissue Doppler echocardiography of medial mitral annular motion. S, peak systolic velocity. Scale, 10 cm/s per division.

Figure 3  .

Figure 3  

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Left: individual rest and peak exercise ejection fraction values for patients with good exercise responses (group I) (solid lines) and poor exercise responses (group II) (dashed lines); in group I mean ejection fraction increased from 55% to 58% (solid squares), and in group II it decreased from 54% to 42% (solid circles). Middle: Distributions of individual values of systolic excursion and peak systolic velocity (right) of medial mitral annular motion, in patients with good exercise response (group I) and poor exercise response (group II). The dotted lines represent the best discriminant cut off values obtained in the analyses of sensitivity and specificity.

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